Bottom Line:
Rates were higher in agricultural East and Central Taiwan and lower in major cities.Almost half (47%) of all pesticide suicides occurred in areas where only 13% of Taiwan's population lived.Easy access to pesticides appears to influence the geographic distribution of suicide in Taiwan, highlighting the potential benefits of targeted prevention strategies such as restricting access to highly toxic pesticides.

Affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.

ABSTRACT

Background: Pesticide self-poisoning is the most commonly used suicide method worldwide, but few studies have investigated the national epidemiology of pesticide suicide in countries where it is a major public health problem. This study aims to investigate geographic variations in pesticide suicide and their impact on the spatial distribution of suicide in Taiwan.

Methods: Smoothed standardized mortality ratios for pesticide suicide (2002-2009) were mapped across Taiwan's 358 districts (median population aged 15 or above = 27 000), and their associations with the size of agricultural workforce were investigated using Bayesian hierarchical models.

Results: In 2002-2009 pesticide poisoning was the third most common suicide method in Taiwan, accounting for 13.6% (4913/36 110) of all suicides. Rates were higher in agricultural East and Central Taiwan and lower in major cities. Almost half (47%) of all pesticide suicides occurred in areas where only 13% of Taiwan's population lived. The geographic distribution of overall suicides was more similar to that of pesticide suicides than non-pesticide suicides. Rural-urban differences in suicide were mostly due to pesticide suicide. Areas where a higher proportion of people worked in agriculture showed higher pesticide suicide rates (adjusted rate ratio [ARR] per standard deviation increase in the proportion of agricultural workers = 1.58, 95% Credible Interval [CrI] 1.44-1.74) and overall suicide rates (ARR = 1.06, 95% CrI 1.03-1.10) but lower non-pesticide suicide rates (ARR = 0.91, 95% CrI 0.87-0.95).

Conclusion: Easy access to pesticides appears to influence the geographic distribution of suicide in Taiwan, highlighting the potential benefits of targeted prevention strategies such as restricting access to highly toxic pesticides.

Mentions:
Figure 1 shows the geographic distributions of smoothed SMRs for (A) pesticide suicide, (B) non-pesticide suicide and (C) overall suicide. The patterns for unsmoothed SMRs were similar but somewhat less clear due to unstable estimates in sparsely populated areas (data not shown). Higher rates of pesticide suicide were found in East and Central Taiwan, with a concentration of the highest rates in the most rural areas (Figure 1A). One hundred and thirty (36.6%) districts had a SMR above two; they accounted for nearly half (46.6%) of all pesticide suicides, but only 13.4% of Taiwan's population aged 15+ live in these areas. In contrast, five major cities showed the lowest rates; they covered 26.8% of overall population but accounted for only 6% of pesticide suicides.

Mentions:
Figure 1 shows the geographic distributions of smoothed SMRs for (A) pesticide suicide, (B) non-pesticide suicide and (C) overall suicide. The patterns for unsmoothed SMRs were similar but somewhat less clear due to unstable estimates in sparsely populated areas (data not shown). Higher rates of pesticide suicide were found in East and Central Taiwan, with a concentration of the highest rates in the most rural areas (Figure 1A). One hundred and thirty (36.6%) districts had a SMR above two; they accounted for nearly half (46.6%) of all pesticide suicides, but only 13.4% of Taiwan's population aged 15+ live in these areas. In contrast, five major cities showed the lowest rates; they covered 26.8% of overall population but accounted for only 6% of pesticide suicides.

Bottom Line:
Rates were higher in agricultural East and Central Taiwan and lower in major cities.Almost half (47%) of all pesticide suicides occurred in areas where only 13% of Taiwan's population lived.Easy access to pesticides appears to influence the geographic distribution of suicide in Taiwan, highlighting the potential benefits of targeted prevention strategies such as restricting access to highly toxic pesticides.

Affiliation:
School of Social and Community Medicine, University of Bristol, Bristol, UK.

ABSTRACT

Background: Pesticide self-poisoning is the most commonly used suicide method worldwide, but few studies have investigated the national epidemiology of pesticide suicide in countries where it is a major public health problem. This study aims to investigate geographic variations in pesticide suicide and their impact on the spatial distribution of suicide in Taiwan.

Methods: Smoothed standardized mortality ratios for pesticide suicide (2002-2009) were mapped across Taiwan's 358 districts (median population aged 15 or above = 27 000), and their associations with the size of agricultural workforce were investigated using Bayesian hierarchical models.

Results: In 2002-2009 pesticide poisoning was the third most common suicide method in Taiwan, accounting for 13.6% (4913/36 110) of all suicides. Rates were higher in agricultural East and Central Taiwan and lower in major cities. Almost half (47%) of all pesticide suicides occurred in areas where only 13% of Taiwan's population lived. The geographic distribution of overall suicides was more similar to that of pesticide suicides than non-pesticide suicides. Rural-urban differences in suicide were mostly due to pesticide suicide. Areas where a higher proportion of people worked in agriculture showed higher pesticide suicide rates (adjusted rate ratio [ARR] per standard deviation increase in the proportion of agricultural workers = 1.58, 95% Credible Interval [CrI] 1.44-1.74) and overall suicide rates (ARR = 1.06, 95% CrI 1.03-1.10) but lower non-pesticide suicide rates (ARR = 0.91, 95% CrI 0.87-0.95).

Conclusion: Easy access to pesticides appears to influence the geographic distribution of suicide in Taiwan, highlighting the potential benefits of targeted prevention strategies such as restricting access to highly toxic pesticides.